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Developmental dyspraxia
| ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D001072 | }} Developmental dyspraxia is one or all of a heterogeneous range of development disorders affecting the initiation, organization and performance of action. It is a diagnosis of exclusion which entails the partial loss of the ability to coordinate and perform certain purposeful movements and gestures, in the absence of other motor or sensory impairments like multiple sclerosis or Parkinson's disease. The concept of developmental dyspraxia has existed for more than a century, but differing interpretation of the terminology remains. Developmental dyspraxia (referred to as developmental coordination disorder (DCD) in the US) is a life-long condition that is more common in males than in females; the exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Current estimates range from 5% - 20% with at least 2% being affected severely. Ripley, Daines, and Barrett state that "Developmental dyspraxia is difficulty getting our bodies to do what we want when we want them to do it", and that this difficulty can be considered significant when it interferes with the normal range of activities expected for a child of their age. Madeline Portwood makes the distinction that dyspraxia is not due to a general medical condition, but that it may be due to immature neuron development. The word "dyspraxia" comes from the Greek words "dys" meaning impaired or abnormal and "praxis", meaning action or deed. Dyspraxia is described as having two main elements: ; Ideational dyspraxia : Difficulty with planning a sequence of coordinated movements. ; Ideo-Motor dyspraxia : Difficulty with executing a plan, even though it is known. Epidemiology Developmental dyspraxia is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition. Assessment and diagnosis Assessments for dyspraxia typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate dyspraxia, including balancing, physical sequencing, touch sensitivity, and variations on walking activities. A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty. However, research in the BJSE has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including Developmental Coordination Disorder, Dyslexia and DAMP. The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge. "Teachers will not be able to recognise or accommodate the child with learning difficulties in class if their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children with learning difficulties." Developmental profiles Various areas of development can be affected by developmental dyspraxia and many or all can persist into adulthood. Often various coping strategies are developed, and these can be enhanced through physiotherapy. Speech and language Developmental verbal dyspraxia is a type of ideational dyspraxia, causing linguistic or phonological impairment. This is the favoured term in the UK; however it is also sometimes referred to as articulatory dyspraxia and in the USA the usual term is apraxia of speech Pam Williams, Developmental Verbal Dyspraxia, Nuffield Hearing & Speech Centre. Key problems include: * Difficulties controlling the speech organs. * Difficulties making speech sounds * Difficulty sequencing sounds ** Within a word ** Forming words into sentences * Difficulty controlling breathing and phonation. * Slow language development. * Difficulty with feeding. Fine motor control Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to either ideational or ideo-motor difficulties. Problems associated with this area may include: * Learning basic movement patterns. * Developing a desired writing speed. * The acquisition of graphemes – e.g. the letters of the Latin alphabet, as well as numbers. * Establishing the correct pencil grip * Hand aching while writing Fine-motor problems can also cause difficulty with a wide variety of other tasks such as using a knife and fork, fastening buttons and shoelaces, cooking, brushing one's teeth, applying cosmetics, styling one's hair, opening jars and packets, locking and unlocking doors, shaving, and doing housework. Whole body movement, coordination, and body image Issues with gross motor coordination mean that major developmental targets including walking, running, climbing and jumping are affected. One area of difficulty involves associative movement, where a passive part of the body moves or twitches in response to a movement in an active part. For example, the support arm and hand twitching as the dominant arm and hand move, or hands turning inwards or outwards to correspond with movements of the feet. Problems associated with this area may include: * Poor timing. * Poor balance (sometimes even falling over in mid-step). Tripping over one's own feet is also not uncommon. * Difficulty combining movements into a controlled sequence. * Difficulty remembering the next movement in a sequence. * Problems with spatial awareness, or proprioception. * Some people with dyspraxia have trouble picking up and holding onto simple objects due to poor muscle tone. * This disorder can cause an individual to be clumsy to the point of knocking things over and bumping into people accidentally. * Some dyspraxics have difficulty in determining left from right. * Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with dyspraxia. * Dyspraxics may also have trouble determining the distance between them and other objects. General difficulties Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, and sound . This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics and including oral toleration of excessively textured food (commonly known as picky eating), or even being touched by another individual (in the case of touch oversensitivity) or may require the consistent use of sunglasses outdoors since sunlight may be intense enough to cause discomfort to a dyspraxic (in the case of light oversensitivity). An aversion to loud music and naturally loud environments (such as clubs and bars) is typical behavior of a dyspraxic individual who suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold environments is typical of a dyspraxic with temperature oversensitivity. Dyspraxic people sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result these people are prone to panic attacks . Having other autistic traits (which is common with dyspraxia and related conditions ) may also contribute to sensory-induced panic attacks. Moderate to extreme difficulty doing physical tasks is experienced by dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly. Some (but not all) dyspraxics suffer from hypotonia, which in this case is chronically low muscle tone caused by dyspraxia . People with this condition have very low muscle strength and endurance (even in comparison with other dyspraxics) and even the simplest physical activities may quickly cause soreness and fatigue, depending on the severity of the hypotonia. Hypotonia may worsen a dyspraxic's already poor balance to the point where it is necessary to constantly lean on sturdy objects for support . Overlap with other conditions Dyspraxics may have other difficulties that are not due to dyspraxia itself but often co-exist with it. They may have characteristics of dyslexia (difficulty with reading and spelling), dyscalculia (difficulty with mathematics), expressive language disorder (difficulty with verbal expression), ADHD (poor attention span and impulsive behaviour), or Asperger syndrome (consisting variously of poor social cognition, a literal understanding of language (making it hard to understand idioms or sarcasm) and rigid, intense interests). However, they are unlikely to have problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is important to understand that a major weakness for one dyspraxic can be a strength or gift for another. For example, while some dyspraxics have difficulty with reading and spelling due to an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant reading and spelling or mathematical abilities. Similarly, some have autistic traits such as lacking an appreciation of irony or social cues, while others thrive on an ironic sense of humour as a bonding tool and a means of coping. Overlap with other conditions Dyspraxics may have other difficulties that are not due to dyspraxia itself but often co-exist with it. This is sometimes referred to as comorbidity. Dyspraxics may have characteristics of dyslexia (difficulty with reading and spelling), dyscalculia (difficulty with mathematics), dysgraphia (an inability to write neatly and/or draw), autism spectrum disorderDziuk, M. A., Gidley Larson, J. C., Apostu, A., Mahone, E. M., Denckla, M. B., & Mostofsky, S. H. (2007). Dyspraxia in autism: Association with motor, social, and communicative deficits. Developmental Medicine and Child Neurology, 49(10), 734-739. http://www.ncbi.nlm.nih.gov/pubmed/17880641 or ADHD (poor attention span and impulsive behaviour). However, they are unlikely to have problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is important to understand that a major weakness for one dyspraxic can be a strength or gift for another. For example, while some dyspraxics have difficulty with reading and spelling due to an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others may have brilliant reading and spelling or mathematical abilities. Some estimates show that up to 50% of dyspraxics have ADHD. Students with dyspraxia struggle most in visual-spatial memory. When compared to their peers who don’t have motor difficulties, students with dyspraxia are seven times more likely than typically developing students to achieve very poor scores in visual-spatial memory. As a result of this working memory impairment, students with dyspraxia have learning deficits as well. Some students with dyspraxia can also have comorbid specific language impairment (SLI). Research has found that students with dyspraxia and normal language skills still experience learning difficulties despite relative strengths in language. This means that for students with dyspraxia their working memory abilities determine their learning difficulties. Any strength in language that they have is not able to sufficiently support their learning. Other names Collier first described developmental dyspraxia as 'congenital maladroitness'. A. Jean Ayres referred to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome'. It has also been called minimal brain dysfunction although the two latter names are no longer in use. Other names include: * Dyspraxia * Developmental Co-ordination Disorder - a subtly different condition by definition, in practice, very similar. * Sensorimotor dysfunction * Perceptuo-motor dysfunction * Motor Learning Difficulties The World Health Organisation currently lists Developmental Dyspraxia as Specific Developmental Disorder of Motor Function. References External links *Dyspraxia Foundation *DANDA The Developmental Adult Neuro-Diversity Association *United States organization for those with Developmental Dyspraxia *http://www.dyspraxiascotland.org.ukDyspraxia page for people in Scotland Category:Neurological disorders Category:Special education de:Dyspraxie eo:Dispraksio fr:Dyspraxie it:Disprassia nl:Dyspraxie fi:Dyspraksia sv:Dyspraxi Category:Movement disorders Category:Special education de:Dyspraxie fr:Dyspraxie nl:Dyspraxie sv:Dyspraxi Definition Description *symptoms *synonyms and related phrases History of the disorder *historical sources *famous clinicans Epidemiology *incidence *prevalence *morbidity *mortality *racial distribution *age distribution *sex distribution Risk factors *known evidence of risk factors *theories of possible risk factors Etiology *known evidence of causes *theories of possible causes Diagnosis & evaluation *psychological tests *differential diagnosis *evaluation protocols Treatment * outcome studies *treatment protocols *treatment considerations *evidenced based treatment *theory based treatment *team working considerations *followup For people with this difficulty *user:how to get help *user:self help materials *user:useful reading *user:useful websites For their carers *carer:how to get help *carer:useful reading *carer:useful websites For the practitioner *practitioner:further reading *practioner:useful websites [[Anonymous fictional case studies for training]]